Survey of Sonoanatomic Distances For Lumbar Medial Branch Nerve Blocks in Healthy Volunteers

Gharaei, Helen,Imani, Farnad,Solaymani-Dodaran, Masoud The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.2

Background: The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). Methods: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. Results: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P < 0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P < 0.001). Conclusions: We found many anatomic distances which may increase awareness of US guided LMBB.

An analytical approach for aeroelastic analysis of tail flutter

Gharaei, Amin,Rabieyan-Najafabadi, Hamid,Nejatbakhsh, Hossein,Ghasemi, Ahmad Reza Techno-Press 2022 Advances in computational design Vol.7 No.1

In this research, the aeroelastic instability of a tail section manufactured from aluminum isotropic material with different shell thickness investigated. For this purpose, the two degrees of freedom flutter analytical approach are used, which is accompanied with simulation by finite element analysis. Using finite element analysis, the geometry parameters such as the center of mass, the aerodynamic center and the shear center are determined. Also, by simulation of finite element method, the bending and torsional stiffnesses for various thickness of the airfoil section are determined. Furthermore, using Lagrange's methods the equations of motion are derived and modal frequency and critical torsional/bending modes are discussed. The results show that with increasing the thickness of the isotropic airfoil section, the flutter and divergence speeds increased. Compared of the obtained results with other research, indicates a good agreement and reliability of this method.

Four-Echelon Integrated Supply Chain Model with Stochastic Constraints Under Shortage Condition: Sequential Quadratic Programming

Gharaei, Abolfazl,Pasandideh, Seyed Hamid Reza Korean Institute of Industrial Engineers 2017 Industrial Engineeering & Management Systems Vol.16 No.3

The present paper focuses on modeling and optimizing a four-echelon integrated supply chain, which consists of a supplier, a producer, a wholesaler and multiple retailers. These echelons interact and agree with each other on having the same period length and stockpiles for each product to make an integrated formation for minimizing the total cost of chain. Resources follow normal distributions with known means and variances. In this regard, stochastic constraints on costs of procurement or production, space and order quantity are considered, and in this, there are several single-stage products considered in shortage condition. The objectives set in this piece are to find both the number of agreed optimum stockpile and agreed optimum period length with the purpose of minimizing the total inventory cost of the chain while the stochastic constraints are met. The model used to clarify the problem is nonlinear and large, and so, the sequential quadratic programming (SQP) developed as more effective algorithm with less iteration adopted for solving the recent convex nonlinear model. A numerical example is also solved to demonstrate the application of this model and to evaluate optimum performance of the newly developed SQP algorithm. The results of the sensitivity analysis illustrate that the intended SQP algorithm has excellent performance in terms of optimality for solving research nonlinear model.

Radiofrequency Thermal Ablation in Painful Myeloma of the Clavicle

Gharaei, Helen,Imani, Farnad,Vakily, Masoud The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.1

A 57-year-old male patient had myeloma. He had severe pain in the left clavicle that did not respond to radiotherapy; therefore, it was treated with radiofrequency thermal ablation (RFTA). Under fluoroscopic guidance, two RF needles at a distance of 1.5 cm from each other were inserted into the mass and conventional radiofrequency ($90^{\circ}C$ and 60 seconds) at two different depths (1 cm apart) was applied. Then, 2 ml of 0.5% ropivacaine along with triamcinolone 40 mg was injected in each needle. The visual analogue pain score (VAS from 0 to 10) was decreased from 8 to 0. In the next 3 months of follow-up, the patient was very satisfied with the procedure and the mass gradually became smaller. There were no complications. This study shows that RFTA could be a useful method for pain management in painful osteolytic myeloma lesions in the clavicle

The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy

Gharaei, Helen,Imani, Farnad,Almasi, Fariba,Solimani, Massoud The Korean Pain Society 2013 The Korean Journal of Pain Vol.26 No.4

Background: Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours. Methods: Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB. Results: There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. Conclusions: This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.

Case Report : Radiofrequency Thermal Ablation in Painful Myeloma of the Clavicle

( Helen Gharaei ),( Farnad Imani ),( Masoud Vakily ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.1

A 57-year-old male patient had myeloma. He had severe pain in the left clavicle that did not respond to radiotherapy; therefore, it was treated with radiofrequency thermal ablation (RFTA). Under fluoroscopic guidance, two RF needles at a distance of 1.5 cm from each other were inserted into the mass and conventional radiofrequency (90oC and 60 seconds) at two different depths (1 cm apart) was applied. Then, 2 ml of 0.5% ropivacaine along with triamcinolone 40 mg was injected in each needle. The visual analogue pain score (VAS from 0 to 10) was decreased from 8 to 0. In the next 3 months of follow-up, the patient was very satisfied with the procedure and the mass gradually became smaller. There were no complications. This study shows that RFTA could be a useful method for pain management in painful osteolytic myeloma lesions in the clavicle (Korean J Pain 2014; 27: 72-76)

KJP : Original Article; The Effect of Ultrasound-guided TAPB on Pain Management after Total Abdominal Hysterectomy

( Helen Gharaei ),( Farnad Imani ),( Fariba Almasi ),( Massoud Solimani ) 대한통증학회 2013 The Korean Journal of Pain Vol.26 No.4

Background: Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours. Methods: Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB. Results: There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P> 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P< 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. Conclusions: This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant. (Korean J Pain 2013; 26: 374-378)

Four-Echelon Integrated Supply Chain Model with Stochastic Constraints Under Shortage Condition

Abolfazl Gharaei,Seyed Hamid Reza Pasandideh 대한산업공학회 2017 Industrial Engineeering & Management Systems Vol.16 No.3

The present paper focuses on modeling and optimizing a four-echelon integrated supply chain, which consists of a supplier, a producer, a wholesaler and multiple retailers. These echelons interact and agree with each other on having the same period length and stockpiles for each product to make an integrated formation for minimizing the total cost of chain. Resources follow normal distributions with known means and variances. In this regard, stochastic constraints on costs of procurement or production, space and order quantity are considered, and in this, there are several singlestage products considered in shortage condition. The objectives set in this piece are to find both the number of agreed optimum stockpile and agreed optimum period length with the purpose of minimizing the total inventory cost of the chain while the stochastic constraints are met. The model used to clarify the problem is nonlinear and large, and so, the sequential quadratic programming (SQP) developed as more effective algorithm with less iteration adopted for solving the recent convex nonlinear model. A numerical example is also solved to demonstrate the application of this model and to evaluate optimum performance of the newly developed SQP algorithm. The results of the sensitivity analysis illustrate that the intended SQP algorithm has excellent performance in terms of optimality for solving research nonlinear model.

Survey of Sonoanatomic Distances For Lumbar Medial Branch Nerve Blocks in Healthy Volunteers

( Helen Gharaei ),( Farnad Imani ),( Masoud Solaymani Dodaran ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.2

The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). Methods: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. Results: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P <0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P <0.001). Conclusions: We found many anatomic distances which may increase awareness of US guided LMBB. (Korean J Pain 2014; 27: 133-138)

Meta-analysis of the prevalence of depression among breast cancer survivors in Iran: an urgent need for community supportive care programs

Hassan Ahmadi Gharaei,Mostafa Dianatinasab,Seyyed Mostafa Kouhestani,Mohammad Fararouei,Hossein Moameri,Reza Pakzad,Reza Ghaiasvand 한국역학회 2019 Epidemiology and Health Vol.41 No.-

OBJECTIVES: Depression, which is the most common comorbidity in breast cancer (BC) patients, has adverse effects on patients’ quality of life, disease progress, and survival. METHODS: The protocol of this study was registered in PROSPERO (registration No. CRD42019121494). We electronically searched published studies through January 2019 with the aim of finding articles that investigated the prevalence of depression among BC survivors. Web of Science, Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar were searched to obtain relevant published studies. This review included 14 cross-sectional and 4 cohort studies published from 2000 to 2018. We used a random-effects model to conduct the meta-analysis and generated a summary estimate for the pooled prevalence with 95% confidence intervals (CIs). A subgroup analysis was also conducted based on the depression assessment tool used and the study design. RESULTS: The total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The pooled prevalence of depression among Iranian women with BC was 46.83% (95% CI, 33.77 to 59.88) with significant heterogeneity (I2=98.5%; p<0.001). The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90% (95% CI, 91.97 to 99.83). The results of the subgroup analyses suggested that the depression assessment tool, year of publication, and study design were sources of heterogeneity. CONCLUSIONS: Our findings indicate a high prevalence of depression among BC patients, underscoring the urgent need for clinicians and health authorities to provide well-defined social and psychological supportive care programs for these patients.